What to learn about Billy Joel’s mind situation : NPR

Billy Joel canceled the remainder of his summer season live shows and introduced that he has a mind situation referred to as regular stress hydrocephalus.

“I am sincerely sorry to disappoint our viewers, and thanks for understanding,” Joel, 76, informed followers in a publish to social media on Friday.

The situation has brought about issues with Joel’s “listening to, imaginative and prescient and stability,” in accordance with the assertion, and his docs suggested him in opposition to performing as a result of it has exacerbated these signs. Joel is present process bodily remedy and says he hopes to return to the stage in the future.

The situation is treatable, however underdiagnosed, docs inform NPR.

By going public along with his prognosis, the musician might assist others, says Dr. Charles Matouk, vice chair of scientific affairs on the division of neurosurgery at Yale Faculty of Medication.

“Billy Joel is extremely courageous,” Matouk says. “Extra individuals are going to be alerted to this drawback and possibly get the assistance they want sooner.”

Listed here are three issues to learn about regular stress hydrocephalus (NPH).

1. It occurs when cerebrospinal fluid builds up within the mind

In wholesome folks, the physique makes about half a liter of cerebrospinal fluid a day, says Dr. Gayatri Devi, director of Park Avenue Neurology in Manhattan. The fluid has a number of capabilities, together with cushioning the mind in opposition to the exhausting, bony cranium, transporting vitamins and eradicating waste.

Usually, the fluid will get reabsorbed by giant veins within the head, nevertheless it would not at all times occur that approach in individuals who have regular stress hydrocephalus.

“What can generally occur is there are some slim bottleneck elements of the system,” Devi says. “And generally in these areas, you possibly can have some construct up over time, as we become old, of proteins and different substances and that causes the fluid to again up.”

This “sludge” that causes the buildup is not effectively understood, nevertheless it is not a part of regular getting old, says Matouk of Yale.

“As a result of your cranium is a closed field, the water wants a approach out or else stress’s going to construct up,” he says.

Regardless of elevated stress on the mind, it is referred to as regular stress hydrocephalus as a result of it occurs so slowly that it stays throughout the regular vary, in accordance with the Cleveland Clinic.

2. Signs are straightforward to overlook

The telltale indicators of regular stress hydrocephalus are issues with strolling, cognitive signs and urinary incontinence. However since sufferers who’ve it are normally over 60, they will seem like regular indicators of getting old.

“All of us have grandmas and grandpas which have hassle strolling as a result of they’ve dangerous hips and knees and their again hurts,” Matouk says. “Each women and men, as you become old, are going to begin having hassle controlling their bladder. … You are going to have hassle along with your reminiscence.”

However when all three occur on the similar time and progressively worsen, that must be an indication that one thing shouldn’t be regular.

That mentioned, it would not at all times occur that approach.

“What makes issues much more difficult is folks do not need to have all three,” Devi says. “They might simply have the urinary drawback. They might simply have the gait drawback. They might simply have the reminiscence drawback.”

What’s extra, generally the motion issues are misdiagnosed as Parkinson’s illness, and the cognitive issues are misdiagnosed as Alzheimer’s. (Although Matouk cautions that Alzheimer’s dementia is completely different from the form of dementia that arises from untreated regular stress hydrocephalus over time.)

As soon as regular stress hydrocephalus is suspected, diagnosing it normally includes a CT scan or a mind MRI. Docs who spoke with NPR mentioned they have not had issue getting insurance coverage to pay for the testing.

Nonetheless, as a result of some radiologists do not know how one can spot it, it may be exhausting to get a prognosis, says Dr. Ryan Lee, assistant professor of neurosurgery at Vanderbilt College Medical Heart. “It does take some persistence on the a part of the one who ordered the take a look at or the household and the affected person” to verify the photographs are evaluated by a specialist, he says.

The subsequent take a look at is normally a lumbar puncture, or spinal faucet, during which docs insert a needle into the spinal canal to gather some spinal fluid. Then they ask the affected person and their relations if any signs have modified. “We even have the bodily therapist consider earlier than and after,” Lee says, to keep away from any form of placebo impact.

3. It is treatable

To alleviate stress on the mind, docs carry out a surgical procedure that includes drilling a gap into the cranium and inserting a shunt into the mind to empty the surplus fluid to be absorbed by one other a part of the physique — normally the stomach.

“As a result of the fluid is getting made constantly, you want one thing that constantly drains the fluid,” says Devi of Park Avenue Neurology.

Surgical procedure is not for everybody and carries dangers, like an infection, however sufferers can normally go house the subsequent day, she says. The sooner regular stress hydrocephalus is caught and handled, the higher.

The surgical procedure is not a remedy, however “the response might be actually exceptional,” says Lee of Vanderbilt.

“Sufferers can go from being in a wheelchair and never in a position to stroll and never in a position to suppose very clearly or bear in mind a lot to having the ability to stroll virtually usually and having an enchancment of their cognition and high quality of life considerably,” he says.

Matouk cautioned that cognitive signs have a tendency to enhance much less dramatically than the opposite signs.

Nonetheless, Matouk, who’s finding out a new, much less invasive process for these sufferers, hopes consciousness of this situation will assist sufferers advocate for themselves.

“There’s only a few issues in medication the place we are able to reverse signs or enhance signs, and this can be a illness the place that is potential,” he says. “So, it is a disgrace if it is missed — and it usually is, for months or years, till the proper prognosis is arrived at.”